Being a CDPAP caregiver for someone with a tracheostomy may seem overwhelming. Here we will discuss the dos and don’ts of tracheostomy care as well as possible complications, communication techniques, and conditions that can cause the need for a tracheostomy.
First, let’s discuss what a tracheostomy is.
What is a Tracheostomy?
Some people use the terms tracheotomy and tracheostomy interchangeably. However, a tracheotomy is simply the incision made in the trachea and can lead to a tracheostomy. This incision can be a temporary solution to an immediate problem. A tracheostomy is a more permanent solution to facilitate the long-term ability to breathe when certain medical conditions are present.
A tracheostomy is an opening created by an incision into the trachea (windpipe). After opening the trachea, the medical professional will place a tube in the incision to keep the stoma (opening) clear. The patient then breathes via the tracheostomy tube instead of their nose or mouth. Breathing issues are relatively common, but only the most critical issues result in a tracheostomy.
Why Would Someone Need a Tracheostomy?
Critically serious medical conditions sometimes require a tracheostomy. These conditions restrict the patient’s ability to breathe naturally and normally. Some of those conditions include:
· An obstruction in your mouth or throat
· Edema (swelling), injury, or pulmonary (lung) conditions that cause difficulty breathing
· Airway reconstruction that is necessary after laryngeal or tracheal surgery
· Airway protection from secretions or food due to difficulty swallowing
· Airway protection following head and neck surgery
· Need for long-term support of a ventilator (breathing machine)
· A tumor that blocks the airway
In many cases, the need for a tracheostomy is evaluated over some time rather than an immediate decision. Tracheostomies are long-term solutions, and should not be performed unless the need is well established.
As with any medical procedure, tracheostomies can sometimes result in complications.
Complications of a Tracheostomy
Any medical condition or procedure has risks. Tracheostomies can have several complications that range from minor issues to major problems. Air can get trapped around your lungs (pneumothorax), inside the deeper layers of your chest (pneumomediastinum), or under your skin around the tracheostomy itself (subcutaneous emphysema).
You might also experience bleeding from your trachea or from the tracheostomy itself, damage to your swallowing tube (esophagus), or injury to the nerve that moves your vocal cords (the recurrent laryngeal nerve).
Blood clots, mucus, or airway walls can block the tracheostomy tube. Blockages are prevented by choosing the correct tube, suctioning the tube according to instructions from your doctor, and humidifying the air in your environment. Proper care of the stoma (opening) is needed to reduce the risk of these complications.
How to Care for Someone With a Tracheostomy
Routine care of a tracheostomy is necessary to keep it clean and to help reduce any risk of complications.
For this care, you will need to gather a few items and then follow a step-by-step process for cleaning both the tracheostomy and the area around it.
Supplies you will need:
- Cotton swabs
- Pipe cleaners or a small brush
- Hydrogen peroxide
- Normal saline (tap water or distilled water can be used instead of saline)
- 4×4 gauze pads
- A clean washcloth
- A clean towel for drying the are
- Fresh gauze for redressing the area
- A basin such as a dishpan (or work near a sink).
Once you have your items gathered (it is a good idea to keep them nearby after you gather them the first time), carefully begin the step-by-step process of caring for the area.
1. Thoroughly wash your hands with soap and water. Always start with clean hands to help keep dirt out of your tracheostomy.
2. Place your hands inside your gloves. Doing this will help keep any skin cells or missed dirt from your hands out of the tracheostomy. It will also help keep any drainage or other dirt or bacteria off of your hands. Using gloves will make the process as sterile as possible.
3. Next, you need to suction the trach tube. You should suction for 10 seconds or less. Your health care provider should show you how to use the suction correctly.
4. Carefully remove the inner cannula of the trach tube. (If there is no inner cannula, you can skip down to step 11 in this process.)
5. Hold the inner cannula over the basin. Next, carefully pour hydrogen peroxide over and into the cannula. Use as much peroxide as you need to make sure that you get the inner cannula thoroughly clean.
6. The next step is to clean the inner cannula. Use your small brush or pipe cleaners for this application. Be as thorough as possible with this process. It is important to get the inner cannula as clean as possible.
7. Use normal saline, tap water, or distilled water to rinse the inner cannula. Distilled water is preferred over tap water if you have a septic tank or use water from a well. The goal is to rinse all the peroxide and grime off the cannula.
8. Dry the inner cannula thoroughly using a clean, dry 4×4 fine mesh gauze pad. Make sure you get the inner cannula as dry as you possibly can. You want to avoid getting water in your tracheostomy.
9. Replace the inner cannula and carefully lock it into place.
10. Remove the soiled gauze around your neck and throw it away. You will replace this with clean gauze when you finish the entire process.
11. Inspect the skin around the stoma. You are checking for redness, hardness, tenderness, drainage, or a foul smell. If you discover any of these conditions, contact your doctor or nurse after you finish caring for the area.
12. Soak the cotton-tipped swabs in a solution of half peroxide and half water. Use the swab soaked in the peroxide and water solution to thoroughly clean the exposed parts of the outer cannula and the skin around the opening. You want to be thorough with the cleaning to help keep bacteria away from the tracheostomy.
13. Wet the clean washcloth with normal saline, tap water, or distilled water. Use the cloth to wipe all traces of peroxide from the cannula and clean the skin around the stoma.
14. Use a clean towel to dry the exposed part of the outer cannula and the skin around the stoma. Again, it is important to get the area as dry as you possibly can to help prevent bacterial growth around your tracheostomy.
15. Replace the trach tube ties with clean ones. Your healthcare provider should have told you how to do this correctly.
One person usually can clean and change the trach alone. Your health care provider should give you instructions about how often you need to perform this cleaning routine. Keeping the tracheostomy and surrounding area clean will help ensure continued health.
It is important to note that you will want to avoid changing or cleaning your trach immediately following a meal. This will help to keep you from getting sick during the process.
Your doctor or nurse should be able to help you create a good schedule for the care of your trach. Keeping the lines of communication open between you and your healthcare provider will help you confidently care for your tracheostomy.
Communicating With a Tracheostomy
Communication with a tracheostomy poses additional challenges in communicating with others. The trach makes speaking as others do a difficult task, so patients may have to find different ways to communicate. Some patients adapt by covering the hole in their tracheostomy with a finger to speak. Others use writing to communicate with the people in their lives.
Out of the box, thinking can help someone with a tracheostomy effectively communicate with people outside of the home. Technology like email or computer-generated voice programs can help patients overcome issues with communication. Communication is only one of the things that must be done differently with a tracheostomy.
Don’ts With a Tracheostomy
You must change how you interact with water when you have a tracheostomy. You must be sure to keep the area dry. This means you shouldn’t submerge yourself in water, but a bath in shallow water is acceptable. No submersion also means that swimming is no longer an option for recreation.
Still, water is not the only problem for tracheostomy patients. You must also be careful around spraying water. Even showering will require extra thought. You should always face away from the showerhead to keep water out of your tracheostomy.
Tracheostomies are long-term solutions that cause life changes in activities and communication methods. They require routine care to keep the airway they provide clear. You must vigilantly monitor for complications and promptly report problems to a doctor or nurse. Caregivers should maintain communication with healthcare professionals to ensure the ongoing overall health of the patient.